HEDIS-Star Care Coordinator

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing whole-person care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 6,000 health care providers, including primary and specialty care physicians, hospitals and ancillary providers. We have operated in the Arizona market for more than 13 years, based in Chandler, Arizona, and are an affiliate of Heritage Provider Network. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost.

To assist, and communicate with AZPC staff, administration, providers, and members on behalf of Arizona Priority Care. The position is primarily responsible for learning the requirements of the HEDIS/STAR measures, monitor & educate members on medication adherence & preventive health.

POSITION DUTIES & RESPONSIBILITES

• Effectively communicate with patients and customers so that patients and other healthcare providers receive proper information and follow up in a timely manner.
• Process requests for prescription refill authorizations in a timely manner. Verifies compliance with refill clinic protocols and procedures. Assists Pharmacists with processing prior authorizations.
• Collaborates effectively with staff from other departments/offices to facilitate safe, appropriate and timely initiation and continuous monitoring of patient care issues for which AZPC is responsible
• Effectively utilizes clinical record systems to procure and record patient information: Health Plan Systems, NextGen, q.HMO, Business Solutions. Continuously updates patient information provided so that patient records are accurately updated.
• Demonstrate knowledge of when to escalate call to provider or pharmacist.
• Offer to answer any additional questions that a person, patient, customer may have.
• Support and maintain and environment which fosters high customer and employee satisfaction and quality service.
• Provide assistance and education about preventive health to members that are in accordance to HEDIS/STARS measure education.
• Provide assistance to members, schedule appointments and complete preventive health services in accordance to HEDIS/STARS measures.
• Review medical records and finalize data entry for medical records loaded into q.Metrics and supplemental databases that substantiate Medicare compliance.
• Prepare for three-month auditing period with Health Plan insurance and CMS.
• Perform other duties as assigned.

EDUCATION, TRAINING AND EXPERIENCE

• High school diploma – Required. College degree preferred.
• Arizona Medical Assistant or Pharmacy Technician Certification required.
• Minimum 1 year experience in healthcare or managed care setting with responsibility for systems and/or projects.
• Knowledge of q.HMO, EzCap and NextGen preferred.
• Ability to find, gather and collect information or data.
• Excellent written and oral communication skills.
• Ability to work independently once oriented to routine and process.
• Intermediate level proficiency with Microsoft Office applications including Word, Excel, Power Point and Access.

*This role requires FT in-office presence for the first 60 days of employment. Hybrid schedule available after initial training period.*